1972968048 NPI number — JUDITH R. DUCLAIR

Table of content: (NPI 1972968048)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972968048 NPI number — JUDITH R. DUCLAIR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JUDITH R. DUCLAIR
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972968048
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHUA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03064-6652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-883-0005
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHUA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03064-6652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-883-0005
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/16/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DUCLAIR
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
RANDY
Authorized Official Title or Position:
CLINICIAN
Authorized Official Telephone Number:
603-785-4420

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  0940 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 1123 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)